i am surgeon dr shahnawaz leghari working as assisstant professor at peoples university of medical and health sciences for women at nawabshah, shaheed benazirabad sindh .

3. Varicose vein

4. VARICOSE VEIN
• A VEIN IS CALLED
VARICOSE ,WHEN IT IS
DILATED ,
TORTUOUS,AND
ELONGATED .

7. SIGN / SYMPTOMS
• Aching.
• Burning
• Heaviness
• Throbbing pain
• Ankle sweeling .
• Itching bleeding .
• Dilated tortuous vein {GSV/SSV}
• Superficial thrombophlebitis
• Eczema, ulceration, lipodermosclerosis.

8. CAUSES
•PRIMARY/IDIOPATHIC CAUSES .
•SECONDARY CAUSES.
Pelvic mass
Pregnancy
DVT
Pelvic surgery / irradiation.

9. RISK FACTORS
• Aging
• Sex
• Family history
• Prolong standing.
• Defective connective tissue/smooth muscles in vein valve .

10. CEAP CLASSIFICATIONS
The descriptive CEAP (Clinical-aEtiology-Anatomy-
Pathophysiology) classification for chronic venous disorders is
widely utilised.

11. FOR CLINICAL CLASSIFICATION:
C0: no signs of venous disease;
C1: telangectasia or reticular veins;
C2: varicose veins;
C3: oedema;
C4a: pigmentation or eczema (some include malleolar flare in
this category);
C4b: lipodermatosclerosis or atrophie blanche;
C5: healed venous ulcer;
C6: active venous ulcer.
Each clinical class is further characterised depending upon whether the patient is
symptomatic (S) or asymptomatic (A),
e.g. C2S.

12. FOR AETIOLOGICAL
 Ec: congenital;
 Ep: primary;
 Es: secondary (post-thrombotic);
 En: no venous cause identified.

13. FOR ANATOMICAL
 As: superficial veins;
 Ap: perforator veins;
 Ad: deep veins;
 An: no venous location identified.

14. FOR PATHOPHYSIOLOGICAL
• Pr: reflux;
• Po: obstruction;
• Pr,o: reflux and obstruction;
• Pn: no venous pathophysiology identifiable.

15. INVESTIGATION
• Ultrasound of abdomen.
• Transabdomen / transvaginal duplex scan
• Doppler ultrasound.
• Duplex ultrasound.
• Venography/varicography.

16. MANAGEMENT
COMPRESSION STOCKINGS.
There is no evidence to suggest that compression
hosiery prevents the occurrence or progression of
varicose veins. Compression hosiery significantly
improves varicose vein symptoms but is not popular with
patients, with compliance rates and long-term tolerance
being universally poor.

17. COMPRESSION HOSIERY ARE CLASSIFIED
ACCORDING TO THE PRESSURE THEY EXERT:
THE BRITISH CLASSIFICATION
Class 1 stockings exert pressure of 14–17 mmhg,
Class 2 exert 18–24 mmhg and
Class 3 exert 25–35 mm hg.

18. COMPRESSION STOCKINGS.

19. SURGERY .
ENDOTHERMAL ABLATION .
LASER ABLATION.
RADIOFREQUENCY ABLATION
.NON ENDOTHEMAL ABLATION.
ULTRASOUND GUIDED FOAM SCLEROTHERAPY.
ENDOVENOUS GLUE.

20. OPEN SURGERY
• SAPHENO-FEMORAL LIGATION AND GSV STRIPPING,
• SAPHENO-POPLETEAL LIGATION ANS SSV STRIPPING
• PHLEBECTOMY
• PERFORATED LIGATION

21. STRIPPING OF GREAT SAPHENOUS VEIN